| NPI | 1164545497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007271A) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2025-06-30 |